6+Adv+Sports+Med-Hip

Objectives

  • Movements and ROM

  • Anatomy (Bony and Soft Tissue)

  • Joint Characteristics

  • Injury Introduction

  • Signs and Symptoms

Movements and ROM

Normal Movements and Range of Motion (ROM)

  • Flexion: 120 degrees

  • Extension: 30 degrees

  • Abduction: 45 degrees

  • Adduction: 20-30 degrees

  • Internal Rotation: 35 degrees

  • External Rotation: 45 degrees

  • Circumduction: Circular movement combining flexion, extension, abduction, and adduction.

Bony Anatomy

Key Bones of the Hip

  • Femur

    • Longest and strongest bone in the body.

  • Inominate Bone (composed of three bones)

    • Pubis

    • Ilium

    • Ischium

  • Sacrum

    • Composed of five fused vertebrae.

    • Acts as an attachment for some hip muscles.

Soft Tissue Anatomy

Ligaments

  • Iliofemoral Ligament

    • Also known as the "Y" ligament or ligament of Bigelow; the strongest ligament in the body.

  • Ischiofemoral Ligament

  • Pubofemoral Ligament

  • Labrum

Muscles

Hip Flexors

  • Iliopsoas

    • Combination of:

      • Psoas Major: Originates from T12-L4 bodies.

      • Psoas Minor: Originates from L1-L5 transverse processes.

      • Iliacus: Originates from iliac fossa.

    • Insertion: Lesser trochanter of the femur.

    • Action: Flexes the hip, slight external rotation.

  • Rectus Femoris

  • Sartorius

Hip Extensors

  • Gluteus Maximus

    • Originates from ilium, sacrum, and lumbodorsal fascia.

    • Insertion: Posterior femur at gluteal tuberosity and IT band.

    • Action: Extends hip, external rotation, abducts, and adducts hip.

  • Hamstrings

Hip Abductors

  • Tensor Fascia Lata

    • Originates anterior ilium and iliac crest.

    • Insertion: IT band at Gerdy's tubercle (anterolateral tibia).

    • Action: Abducts hip, flexes and internally rotates leg.

  • Gluteus Medius

    • Originates from ilium just below iliac crest.

    • Insertion: Greater trochanter.

    • Action: Stabilizes pelvis, abducts leg.

  • Gluteus Minimus

    • Originates from ilium below glute med.

    • Insertion: Anterior greater trochanter.

    • Action: Stabilizes pelvis, abducts leg.

Hip Adductors

  • Adductor Magnus

    • Originates from pubis, ischium, and ischial tuberosity.

    • Insertion: Adductor tubercle and femur.

    • Action: Adduction and extension of leg.

  • Adductor Longus

    • Originates from pubis.

    • Insertion: Femur medially at linea aspera.

    • Action: Adduction of leg.

  • Gracilis

  • Adductor Brevis

  • Pectineus

External Rotators (P-GO-Q Muscles)

  • Six muscles:

    • Piriformis: Originates from sacrum; acts on external rotation.

    • Gemelli (Superior and Inferior)

    • Obturator Internus and Externus

    • Quadratus Femoris

Femoral (Inguinal) Triangle

  • Important for emergency treatment.

  • Formed by:

    • Inguinal Ligament

    • Sartorius

    • Adductor Longus

  • Houses structures referred to with the acronym NAVAL:

    • N - Nerve (Femoral)

    • A - Artery (Femoral)

    • V - Vein (Femoral)

    • AL - Adductor Longus

Joint Characteristics

  • Very stable joint.

  • Inominate rotates during gait.

  • Site for multiple muscle attachments, which can lead to changes in alignment due to muscle tightness.

Injury Overview

Quad Contusion

  • Mechanism of Injury (MOI): Blow to the quadriceps.

  • Grading Scale Based on ROM:

    • Grade 1: Full ROM or 90-135 degrees.

    • Grade 2: 60-90 degrees.

    • Grade 3: Less than 60 degrees.

  • Signs/Symptoms: Pain with palpation, swelling/hematoma formation, discoloration, difficulty with knee flexion, pain with quad activation.

  • Treatment: Ice with compression, potential use of crutches, protective pad, light massage post-injury.

Myositis Ossificans

  • MOI: Repeated muscle contusions.

  • Signs/Symptoms: Pain with use, localized swelling, significant decrease in flexion ROM, palpable mass in muscle, observed bone on x-ray.

  • Treatment: Remove from activity, ultrasound to break up bony development, light massage, restore ROM and muscle function as tolerated.

Iliotibial (IT) Band Related Injury

  • MOI: Overuse injury (IT band friction syndrome).

  • Signs/Symptoms: Pain at greater trochanter or lateral knee, clicking during hip or knee transition from flexion to extension, tight IT bands.

  • Treatment: Correct biomechanical imbalances (shoes, arches, muscle weakness), improve IT band flexibility through massage and stretching.

Hip Pointer

  • MOI: Blow to or fall on iliac crest, causing bony bruising and compression.

  • Signs/Symptoms: Discoloration, swelling, pain with palpation, muscle activation, stretching, and during gait.

  • Treatment: Control inflammation, maintain flexibility, and decrease muscle spasm.

Muscle Strains

  • Common hip injuries include strains of:

    • Groin (adductors)

    • Hamstrings

    • Quads

    • Hip flexors.

  • MOI: Usually a powerful eccentric contraction; may also occur during powerful concentric contractions.

  • Signs/Symptoms: Pain with use/overstretch, palpation pain, varying levels of strength loss.

Hip Dislocation

  • Very rare due to joint stability, about 90% occur posteriorly.

  • MOI: Femur forced posteriorly out of socket (often from a car crash or high fall).

  • Signs/Symptoms: FADIR (Flexion, Adduction, Internal Rotation) deformity, extreme pain, inability to bear weight.

  • Treatment: Medical emergency; reduced by a medical professional, usually under anesthesia.

Other Common Hip Injuries

  • Femur Fractures (shaft vs neck)

  • Femoral-acetabular Impingement (FAI)

  • Labral Tears

  • Iliopsoas Bursitis ("Snapping Hip")